Outline

Objective: We present a consecutive series of 49 patients with skull base chordoma.

Methods: Retrospective analysis of 29 male and 20 female patients (mean age 39.0Â±15 years) who underwent a total of 85 operations between 1979 and 2002 in Nordstadtkrankenhaus Hannover.

Results: Most patients presented preoperatively with abducens nerve palsy (45%). A large variety of approaches were used, most often the transethmoidal approach (36.3%) followed by the pterional approach (23.4%) and the retrosigmoid approach (23.4%). Neuroradiological analysis of 26 patients showed a mean volume of 23.4 ml, with all tumours arising from the midline and involving the clivus. Lateral extension to the petrous bone was present in 54%. Tumour removal was radical in 49% of all and in 78% of the primary surgical procedures. In 37 patients a follow-up with a mean interval of 63 months after primary surgery could be obtained. 51% of these patients received various types of radiation therapy. Seventeen patients are still alive with a mean Karnofsky index of 90%. Neither the lengthening of the time between initial surgery and re-operation for tumour recurrence, nor the increase of the overall survival turned out to be statistically significant in patients who underwent radical surgery as opposed to non radical surgery. However, the clinical outcome was significantly better following non radical tumour removal. The overall 5 and 10 year survival rates are 65% and 39%.

Conclusions: Although the aim should be a maximal cytoreduction, it should not compromise quality of life since skull base chordomas cannot be cured surgically and radical tumour removal does not increase significantly survival rates in patients with skull base chordomas.